Children 8 to 12 years

There are a number of behaviours and stages that any child goes through regardless of whether or not they have diabetes and it is important as a parent to understand these behaviours and how they may impact on the child’s diabetes.

A child aged 8–12 years with or without diabetes

• Becomes more practical, leaving their magical thinking and vivid imagination behind
• Starts to separate from you, becomes more independent, and may have secrets from you
• Becomes more self-aware
• Becomes more social
• Usually prefers to have friends of the same sex
• Begins to understand their strong and weak points and those of others too
• Solves problems more easily
• Starts to express themselves more clearly
• Enjoys being creative
• Becomes more self-conscious
• May have school phobia and “pretend” illnesses
• May sometimes lie or steal to avoid confrontation
• Becomes more interested in the outside world
• May worry about family issues like arguments, illness or death
• May worry about disasters seen on television or in movies
• Starts to rely more on the approval of friends and are interested in people beyond the family
• Becomes more sexually aware, although this can happen earlier
• Begins to want more control and may start questioning rules

Look for indications of how your child is coping.

Your child may:

• Appear to accept having diabetes yet can be sad, angry or worried for you and themselves. This could be the reason for unusual, unexplained behaviour from your child. Reassure your child that you will all get through this together and that life goes on.

• Feel that you have let them down because they are used to being protected by you and now you can’t make their diabetes go away. You may need to explain to your child that sometimes things are just outside your power; that things happen out of the blue and unfortunately can’t be changed.

• Believe that diabetes has happened to them for a reason, perhaps because of something they have done wrong such as being nasty to their brother or sister. Frequent reassurance from you that diabetes happens to all different children, and is not a punishment, will help them. Meeting other children at diabetes camps or day activities helps your child to feel less isolated.

• Wish their diabetes away and try and ignore it. Sometimes they may be tempted to miss tests and injections or make up blood glucose results. Extra supervision may be needed despite your child insisting they can manage by themselves.

• Feel “different” at a time when they are becoming more sociable. Their friends are becoming important to them and they want to be like them. Reassure your child that everyone has difficulties to overcome – diabetes needs a bit more thought but shouldn’t stop them from doing everything that their friends do.

• Begin to lose confidence because diabetes makes them different. This may lead to them turning down invitations, for example to sleep overs. Encourage your child’s friends to come and sleep at your house which may help everyone to feel more comfortable – then gradually, as they become more confident suggest they go over to their friend’s house. Talk to their friend’s parent(s) so that they feel comfortable – sometimes a parent worries more than a child

• Be curious about diabetes and related tasks – at first it’s all new but then they realise that the diabetes won’t go away which may make them angry. Your support and encouragement is important to their self-esteem and self-worth.

• See diabetes as a barrier to joining in team sports that are of interest to them. Encourage them to join in and reassure them that they can try anything. As your child gets older they will begin to learn to take on more responsibilities – dialling up insulin and giving their injection – but they may still require your supervision and support when it becomes too much.

• Capable of preparing simple foods and can start to recognise suitable foods and the need to eat regularly. Encourage your child to help at mealtimes and be involved with preparing food for school/sport.

• Better able to understand safety and danger and so they become more aware of the importance of eating extra snacks, for example before physical activity. Gentle reminders may be needed.

Children must have adult supervision for diabetes-related tasks but as they get older they will gradually begin to take on some of these tasks themselves.

Try to encourage some responsibility (for example, ask them to go and collect their meter) but ultimately you are responsible. Your child may not have much concept of time, so you will need to make sure snacks and insulin for instance, are given on time.

You may gradually transfer some tasks to your child. This varies according to their abilities and interest. Sometimes children become over-enthusiastic, then get fed up and want to give back the task or don’t do the task very well.

Breaking up the tasks into smaller steps rather than learning too much at a time may help your child to feel more confident.

When your child is younger handling small things such as syringes/insulin pens may be difficult as fine motor coordination is still in the process of development.

Your child is able to cooperate with you by sitting still for a finger prick and insulin injection. Being able to choose a finger or a site for injection makes them feel as though they’re helping and have some control.

Your child can tell you when they feel hungry but they may be a bit vague in their description of hypo symptoms. They may not say “I’m having a hypo”, they are more likely to say “I feel wobbly, funny”.

You can never be sure that your child knows their hypo symptoms. It is a good idea to draw attention to symptoms straight after a hypo occurs so that your child can talk them over with you. This will help them to remember how they feel and the warning signs of a hypo.

Helping children with diabetes is a challenge for most parents. You may feel guilty or angry (sometimes both) and you may become over protective or very critical. This may result in asking your child to take on too much responsibility before they are ready, or may squash their expression of interest in helping with diabetes related tasks.

Common questions asked are:

• When should my child take on more responsibility?
• Am I asking too much or too little?

All children are different – what works for one child may not work for another.

By the time your child is 8 years old they will usually have the skills to physically do the task but not the maturity and knowledge to take on full responsibility. Taking on some of this responsibility requires that your child learns more about diabetes.

Group sessions with children of a similar age may help. Check what is available through your diabetes team.

There is no special age when your child should give their own injections/work their pump. Health professionals agree that by age 11–13 years, most children can perform most diabetes related tasks but this varies from child to child. As a guide, a child of 10 may be giving the injection and at 11 they may be drawing/dialling up the insulin. If your child refuses to give their own insulin – reduce the steps to one at a time, encouraging your child to join in at each point, but allowing them to ‘opt out’.

The steps could be:

• Check the dosage
• Dial up the insulin
• Select the injection site
• Inject the insulin

These steps may need to be introduced a few days apart and should be done when you have time to spare and you’re not too rushed – on weekends for example.

Sharing tasks between both parents and the child is useful – for example Mum a.m., Dad p.m., child on weekends. Often children will be keen to help.

Concentrate on your child learning one task at a time, otherwise demands are too great and your child will be confused and unwilling to stick at it.

Your child’s skills may not be as good as your own, so patience is needed to increase their confidence. This is another reason for choosing a less rushed time of the day to try out new steps and tasks.

Encourage involvement when your child shows an interest in learning new tasks. It’s still important to observe your child’s ability and technique to avoid possible mistakes and short cuts. Aim to be positive and focus on the things they do well.

Make it clear to your child that you will slowly introduce responsibility, and that you realise they may sometimes need a break. Let them know that you will help them with diabetes tasks for short periods of time.

It’s very easy for you as a parent to carry on doing everything for your child whether they have diabetes or not, but it is vital for your child’s self-esteem and confidence, and your sanity, that you encourage the beginnings of self-care.

AT SCHOOL

Some children do not want anyone outside the family to know that they have diabetes. However, it may be helpful for your child to tell their close friends what to do, especially if a hypo occurs when they are at school.

Your child will need the help of their peers and may need a guiding hand to deal with classmates and friends.

Some children may be happy to ‘show and tell’ about having diabetes. If your child has had diabetes from an early age they may have told everyone – a lot depends on their personality. Other children may be more private in which case your advice as to how to go about telling their friends may be helpful. Together you can practice what to say.

Your child might like to do a school project on diabetes to tell their classmates how it is to have diabetes – for example, they could show how they use their meter. This may increase confidence through teaching their friends.

School events may motivate your child to help in self-care – for example, learning to correctly treat hypos so that they may attend sports events or school excursions.

Your child may be keen to sleep-over at a friend or relative’s house which may provide a gentle push to take on responsibility for some diabetes related tasks – seize every opportunity you can.

Having a small group of your child’s close friends see how the equipment is used, and directing simple, age appropriate discussion can help the more sensitive child.

Education days or support groups may be organised by your local diabetes centre to help you and your child meet other children with diabetes and their parents.

Camps are invaluable to help you and your child feel less isolated. In some states there are parent/child weekend camps which provide an introduction to the concept of the camping experience. Your child may then graduate to other camps throughout their childhood right up to adolescence.

Contact Diabetes NSW or Diabetes Australia in other states for information about camps.

• Use simple terms and answer questions simply, as they arise.
• Don’t overload your child with too much information. Give a step by step introduction to tasks. Do one task at a time, and when neither of you is too tired.
• Acknowledge your child’s feelings especially when they’re frustrated, tired and fed up. Setting limits as you would for your other children is very important. It helps children to feel safe.
• Children often absorb more than we think – they take in information along the way.
• Give your child some relief, share injection and blood glucose tasks.
• Quietly praise your child when they take on any new responsibility.
• Try not to expect perfection.
• Children can benefit from you directing them to help express their frustrations.
• Be positive and give lots of hugs.
• When your child gets older you can gradually increase responsibility.
• Watch for things which encourage your child; at home, at school; with friends.
• Help, support, and supervise your child.
• Choose a quiet time of the day to start a new task.
• Remind your child that diabetes is not their fault.
• Too much responsibility too soon can lead to burnout and poor diabetes care /management.

After diagnosis you may be reluctant to let your child out of your sight to go to school. For you and your child’s sake it is a good time to encourage independence and adapt to diabetes.

To take this step you must feel comfortable that your child will be safe as well as happy.

You can ask your diabetes educator to visit the school to talk to the staff so that they in turn feel comfortable with the situation. The teachers are usually helpful and only too pleased to assist. There are many useful resources on this website to assist  Teachers and Schools.

It’s safer for your child to remain in class to check their blood glucose level (BGL), rather than walking to the office. Otherwise their BGL will drop even lower and be harder to treat.

As you child gets older they may be embarrassed if you go to school to check their blood glucose level (BGL). Your child’s meter should be taken to school for them to test as necessary.

It is essential for you to provide one or two hypo kits for the school staff to store in a prominent, handy place. Remember to restock hypo kits regularly. A photograph of your child placed in the staff room with details of hypo symptoms is also helpful. An emergency action poster next to the photo, as a reminder, is a good idea.

Your child should wear some type of diabetes identification chain or bracelet. This habit is a good one to encourage at a young age as they may maintain the habit as they get older.

Encourage your child to speak up if feeling unwell. Friends and peers can be a great help at school.

Your child may be eligible for special provision for exams (e.g. Basic Skills Test in NSW for children in year 3 and 5). This may allow your child extra time and toilet or rest breaks. Discuss with your child’s school, well before the exam date.

For more information on diabetes at school please go to the Teachers and Schools page.

Your child may be eligible for special provision for exams (e.g. NAPLAN Test in NSW for children in year 3, 5, 7 and 9). This may allow your child extra time and toilet or rest breaks.

Provisions are made on an individual basis with recommendations from your doctor.

You can obtain further information from your teenager's school, Diabetes Australia or The Department of Education. Or go to Useful Links to see a list of contacts in your State or Territory.

 Ages 8-12 - Experience a change in eating habits

An older child takes more responsibility for their food choices. They may also receive more pocket money, so their buying power increases. Food is an important part of socialising and money is often spent on food.

Pressure from friends and a growing sense of self-awareness become an important influence in food choices.

As a child progresses to adolescence, changes in eating habits may be a way in which they express their new found identity. Fast foods and takeaways are popular, as is snacking, and skipping meals sometimes becomes a habit.

Snacking is part of a child’s eating patterns and significant amounts of nutrients are obtained from snacks – often up to a quarter of their daily energy needs and one third of other nutrients e.g. iron and calcium. Ensuring a supply of healthy snacks is therefore important.

Eat Meals Away From Home

Your child is now eating more meals away from the family home, including school lunches. At this time your child may want to swap lunches (lots of yummy treats in a friend’s lunch box) and start to skip meals (no time to eat and play!).

Here Are A Few Helpful Hints:

• Offer a variety of lunch options that look good and are quick to eat.
• Separate snacks and lunches into different wraps or containers - so that your child can easily find the right food package for each meal.
• Freeze foods the night before to keep them looking and tasting fresh.
• Get your child involved in food preparation. The meal may be more likely to be eaten if it has been selected and made by the child themselves.

LUNCH IDEAS 

• Sandwich fingers or triangles
• Crackers and reduced fat cheese
• Rolls, bagels or wraps
• Small container of pasta salad

SNACK IDEAS 

• Whole fresh fruit or bite sized fruit pieces
• Low fat yoghurt or dairy desserts
• Dried fruit packets (e.g. sultanas or apple)
• Fruit in zip lock bags (e.g. grapes, cherries or strawberries)
• Fruit snack packs (e.g. peaches in natural juice)
• Wholegrain crispbread eg. Vita-weats
• Wholegrain rice crackers
• Pikelets, crumpets or English muffins
• Homemade fruit muffins
• Low fat milk tetra pack (freeze the night before)
• Muesli bar
• Fruit loaf/toast
• Fruit filled biscuits
• Popcorn
• Breakfast cereal
• Toasted sandwich/jaffle

If demands for ‘special occasion foods’ increase (such as crisps and chocolate) “because that’s what everyone else gets”, it’s best to compromise by including treats for special occasions. Taking a balanced approach helps to teach your child about the difference between ‘everyday’ and ‘special occasion’ foods. These rules should apply equally to siblings and other family members.

Enjoys food in an expanding social scene

When a child starts school they may begin to separate from their parents, and rely more on approval from friends. This is a time of growing independence and socialising – sleepovers, camps, parties – fun. Staying over with their friends at night and sharing meals with their friends’ families becomes important in their social development.

Varying appetite – varying insulin dose

A child’s appetite varies during this time, usually indicating the body’s need for food. Growth spurts or periods of lots of activity are times when they will usually eat more. To cater for these changes, insulin dosage may need to be adjusted. This does not mean their diabetes is worsening as is sometimes believed. It’s an inevitable part of the growing process.

Talk to your doctor or diabetes educator about these adjustments. Frequent reviews (at least once a year) of meal plans by a dietitian are essential to ensure normal growth.

As they get older, children may be able to stay up later on some nights (such as the weekend). At times like this, it may be appropriate to give them a second supper to prevent hypos. Check their blood glucose levels (BGLs) to help to decide if this is necessary.

With increasing appetite it’s important to offer extra healthy food choices (e.g. fruit, vegetables, dairy foods) and seek advice on changes to insulin dosage to maintain good blood glucose control. Talk to your child’s doctor or educator.  

Sharing decisions about food choices

Along with their growing responsibilities for day-to-day tasks come the responsibilities of diabetes. A child at this stage is usually cooperative, willing to learn new tasks and responds to encouragement.

Learning about healthy food choices and understanding which foods (carbohydrates) affect BGL's is appropriate and possible. Helping out with cooking and making food choices in the supermarket are practical and fun ways for your child to learn.

Teachers, other parents and carers need to be informed that your child has diabetes – so they can be prepared. However, making a fuss about your child’s food choices may cause them to feel different and singled out. This is certainly the case if one child is seen to get more attention than other children. So providing a few simple guidelines for other people is best.

Your child should be allowed to enjoy the foods offered at the party, including snack foods and birthday cake like other children.

It's helpful if teachers can inform parents in advance of special parties so they are aware of the cause of a possible rise in their child's BGLs.

If your child needs to take a plate for a party at school, here's some great party food ideas which can be enjoyed by everyone:

• Fairy bread
• Mini pizzas
• Potato wedges
• 
 Pretzels
• 
 Low joule jelly cups
• 
 Mini muffins
• Dips and crackers
• Popcorn
• Ribbon sandwiches
• 
 Diet soft drink
• 
 Pikelets
• 
 Fruit kebabs

You may be concerned when your child is away from home - will they eat enough carbohydrate so they don't have a hypo?


Teaching your child about carbohydrate foods and quantities they need to eat is important. Extra fats or sugars occasionally are not going to be harmful in the long term.


Encouraging them to make their own decisions about how much they need to eat at meals at home is a good place to start. With this confidence they may deal with other situations more easily.

Making carbohydrate choices at meal times should not be difficult - offer selections from potato, corn, sweet potato, rice, pasta or bread. Desserts can also be nutritious and offer another carbohydrate alternative -try fruit or dairy based desserts such as fruit salad, yoghurt, banana split, custard or canned fruit.

Allowing your child to join in outings, sleep-overs and camps helps them to learn to share responsibility for their diabetes. Older school-age children are often ready to do more of their diabetes care, such as making their own food choices, assisting with cooking meals and even reading food labels.

The checklist should include the following:

• Hypo food - quickly absorbed carbohydrates - eg juice, jelly beans, sugar sachets and follow up carbohydrates - eg crackers, biscuits, dried fruit
• 
 Extra carbohydrate snacks
• 
 Insulin
• Syringe or pen
• Blood glucose meter and test strips
• Tissues

At some time, either during a school outing or after school, your child will be exposed to fast foods. Takeaway outlets offer a variety of foods that are fast, fun and definitely appealing to children. Many of these foods are high in fat and salt and lack fibre; however they can be enjoyed from time to time. The type and amount of carbohydrate and fat are important considerations.

Better Choices Are:

• Sushi rolls
• A baked potato with low fat fillings
• A wrap – filled with lean meat and salad
• BBQ chicken roll (skip the skin)
• Regular burger with salad
• Doner kebab and salad
• Toasted sandwiches or focaccia
• Grilled fish and small serve chips
• Asian stir-fry or noodle dishes
• Burritos
• Vegetable based pizzas

Encourage your child to avoid sugary drinks like soft drink or fruit drinks (unless they are having a hypo) and choose plain water as the best everyday drink. Diet soft drink or diet cordial is also suitable occasionally.

Carrying easily absorbed carbohydrate (e.g. fruit juice popper or glucose gel) at all times is another task to be learned and increase a child's sense of independence.

Exercise and sport may become more active, prolonged and routine, especially if played after school. Insulin doses may need to be adjusted and you may need to experiment with the amount and types of food to learn what suits your child’s needs.

For example, dried fruit and crackers are quick to eat.

Reminding your child to have BGL's checked before and after the activity, as well as topping up with carbohydrate foods is important. Talking to your dietitian and/or diabetes educator often helps.

Planning For Sport and Exercise

 If extra activity is planned, your child may need additional carbohydrate food prior to the exercise.  A general guide is a half to one extra carbohydrate exchange (7-15g carbohydrate) for every 30 minutes of physical activity.  However the exact amount needed will be determined by the level of activity and blood glucose response to exercise.

Exercise increases the body’s sensitivity to insulin (increasing the risk of hypos) and this effect may continue for up to 12-16 hours following the activity.  There is a lot of variation between individuals regarding these effects, so it is important to monitor your child’s blood glucose levels (BGLs) closely before, during and after exercise.

If regular exercise is expected, such as a sports day at school or swimming on the weekend, you may wish to discuss with your child’s doctor the need to reduce the insulin dosage on these days.

Carbohydrate foods for sport

• Muesli bar
• Pack of sultanas
• Sandwich
• Low fat flavoured milk
• Dried apricots
• Fresh fruit

If your child is involved in an endurance/long sporting event, they may need extra carbohydrate during and after the event to prevent a low BGL.  A carbohydrate containing drink such as a sports drink can be handy, providing both fluid for hydration and carbohydrate for energy.  Talk to your dietitian about suitable choices.

Although hypo symptoms are individual, mid-morning sleepiness, poor attention just before morning recess, or headaches, are common signs of low BGL's. It’s important to give a supply of hypo foods to your child and your child’s school teacher. These items could be kept in a separate lunch box in your child’s bag as well as in the class room

It is vital for teachers to understand the need for your child to sometimes eat a snack during class time to treat a hypo. This is best explained to them by you or your child’s diabetes educator.

Initially, fitting diabetes into the school day can be a balancing act. Depending on your child’s insulin plan and school routine, sometimes a before school snack may be necessary to prevent a hypo before recess. At the same time, preventing your child from feeling different by ensuring meals (such as recesses and lunch) are at the same time as the other children is essential. Your diabetes team can help work out your child’s insulin plan around their usual school routine.

Teachers may also be able to pick up the signs of a hypo and treat early if they are well informed. 

They also need to be aware of avoiding delays in meal times and most importantly when treating hypos.  Packing snacks for your child to eat during the school is one way to ensure they have enough food to eat to prevent hypos.  This is particularly relevant if there’s a school day with extra activity planned such as sports day.

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